Improving continuity of patient care across sectors: study protocol of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

Background: Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a structured programme (VESPEERA) to improve the admission and discharge process. Methods: We will conduct an open quasi-experimental multi-centre study with four intervention arms. A cohort selected from insurance claims data will serve as a control group reflecting usual care. The intervention will be implemented in 25 hospital departments and 115 general practices in 9 districts in Baden-Wurttemberg. Eligibility criteria for patients are: age > 18 years, hospital admission or hospitalisation, insurance at the sickness fund “AOK Baden-Wurttemberg”, enrolment in general practice-centred care contract. Each study arm will receive different intervention components based on the point of study enrolment and the patient’s medical need. The interventions comprise a) a structured assessment in the general practice prior to admission resulting in an admission letter b) a discharge conversation by phone between hospital and general practice, c) a structured assessment and care plan post-discharge and d) telephone monitoring for patients with a high risk of rehospitalisation. The assessments are supported by a software tool (“CareCockpit”), originally developed for structured case management programmes. The primary outcome (rehospitalisation due to the same indication within 90 days) and a range of secondary outcomes (rehospitalisation due to the same indication within 30 days; hospitalisations due to ambulatory care-sensitive conditions; delayed prescription of medication and medical products/ devices and referral to other health practitioner/s after discharge; utilisation of emergency or rescue services within 3 months; average care cost per year and patient participating in the VESPEERA programme) and quality indicators will be determined based on insurance claims data and CareCockpit data. Additionally, a patient survey on satisfaction with cross-sectoral care and health related quality of life will be conducted. Discussion: Based on the results, area-wide implementation in usual care is well sought. This study will contribute to an improvement of cross-sectoral care during the admission and discharge process. Trial registration: DRKS00014294 on DRKS / Universal Trial Number (UTN): U1111–1210-9657, Date of registration 12/06/2018

Building climate resilience: awareness of climate change adaptation in German outpatient medical practices

Abstract Background Climate change is seen as the biggest health threat of the twenty-first century. Making outpatient medical practices resilient is therefore crucial to protect vulnerable groups and maintain quality of care. Awareness is a precondition for action. This study aims to explore awareness (knowledge, experience and attention) of climate change adaptation among stakeholders of outpatient medical practices. Methods Semi-structured interviews and focus groups with stakeholders of outpatient medical practices were conducted. The qualitative data were analysed in a two-step Thematic Analysis process. Results In total, n = 40 stakeholders participated in two focus groups and 26 interviews. The findings show a mixed degree of awareness in outpatient medical practices. The spectrum ranged from a passive role with curative acting only, handing over responsibility to others and a low perceived self-efficacy to a proactive and responsible implementation of adaptation strategies. Participants who saw the need and responsibility of climate change adaptation in medical practices perceived low additional workload. In general, implementation of climate change adaptation measures and general awareness of climate change adaptation appeared to be depending on a certain tension for change and a higher self-efficacy. Conclusion Medical practices, and specifically primary care, plays a crucial role in climate change adaptation, and awareness needs to be increased further in order to cope with consequences of climate change. To facilitate this, there should be a strong emphasis on climate change adaptation strategies being part of outpatient care provider roles rather than being perceived as an “add-on” to already high workloads

Additional file 1 of Building climate resilience: awareness of climate change adaptation in German outpatient medical practices

Additional file 1: Table S1. List of discussed and experienced adaptation strategies in Outpatient medical practices in Germany

Secondary data in diabetes surveillance – co-operation projects and definition of references on the documented prevalence of diabetes

In addition to the Robert Koch Institute’s health surveys, analyses of secondary data are essential to successfully developing a regular and comprehensive description of the progression of diabetes as part of the Robert Koch Institute’s diabetes surveillance. Mainly, this is due to the large sample size and the fact that secondary data are routinely collected, which allows for highly stratified analyses in short time intervals. The fragmented availability of data means that various sources of secondary data are required in order to provide data for the indicators in the four fields of action for diabetes surveillance. Thus, a milestone in the project was to check the suitability of different data sources for their usability and to carry out analyses. Against this backdrop, co-operation projects were specifically funded in the context of diabetes surveillance. This article presents the results that were achieved in co-operation projects between 2016 and 2018 that focused on a range of topics: from evaluating the usability of secondary data to statistically modelling the development of epidemiological indices. Moreover, based on the data of the around 70 million people covered by statutory health insurance, an initial estimate was calculated for the documented prevalence of type 2 diabetes for the years 2010 and 2011. To comparably integrate these prevalences over the years in diabetes surveillance, a reference definition was established with external expertise.Peer Reviewe

Sekundärdaten in der Diabetes-Surveillance – Kooperationsprojekte und Referenzdefinition zur administrativen Diabetesprävalenz

Neben den Gesundheitssurveys des Robert Koch-Instituts ist die zusätzliche Verwendung von Ergebnissen aus Sekundärdatenanalysen für die Zielsetzung einer wiederkehrenden und umfassenden Beschreibung des Diabetesgeschehens im Rahmen der Diabetes-Surveillance am Robert Koch-Institut unerlässlich. Die wesentlichen Gründe hierfür liegen im großen Stichprobenumfang und der routinemäßigen Erfassung der Sekundärdaten, die tief stratifizierte Auswertungen in zeitlich dichter Folge erlauben. Aufgrund der fragmentierten Datenlage sind verschiedene Sekundärdatenquellen notwendig, um die Indikatoren der vier Handlungsfelder der Diabetes-Surveillance mit Ergebnissen zu befüllen. Somit war ein Meilenstein im Projekt, die Eignung verschiedener Datenquellen auf ihre Nutzbarkeit hin zu prüfen und Analysen durchzuführen. Für diese Aufgabe wurden im Rahmen der Diabetes-Surveillance gezielt Kooperationsprojekte gefördert. In diesem Beitrag werden die Ergebnisse der Kooperationsprojekte aus den Jahren 2016 bis 2018 vorgestellt, die thematisch von der Prüfung der Eignung von Sekundärdaten bis hin zur statistischen Modellierung der Entwicklung epidemiologischer Kennzahlen reichen. Daneben wurden auf Grundlage aller rund 70 Millionen gesetzlich Krankenversicherten erste dokumentierte Prävalenzen des Typ-2-Diabetes für die Jahre 2010 und 2011 geschätzt. Um diese Prävalenzen über die Jahre vergleichbar in die Diabetes-Surveillance zu integrieren, wurde zusammen mit externer Expertise eine Referenzdefinition abgestimmt.Peer Reviewe